Care Management Nurse or Social Worker

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Every day, Cambia’s dedicated team of clinical professionals are living our mission to make health care easier and lives better. As a member of the Care Management team, our Care Management Clinicians provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor and evaluate care as needed – all in service of making our members’ health journeys easier. Are you a dedicated clinical professional passionate about making healthcare more accessible and effective? Are you ready to make a meaningful impact on members' health journeys every day? Then this role may be the perfect fit.

Collect in-depth information about member situations and functioning to identify individual needs, then develop specific objectives, goals, and actions to address those needs Execute case management activities while organizing, securing, integrating and modifying resources to accomplish established goals Gather information to determine plan effectiveness and measure success in reaching desired outcomes Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care using evidence-based criteria that incorporates current and validated clinical research findings Practice within scope of license and consult with physician advisors to ensure clinically appropriate determinations Serve as a resource to internal and external customers, collaborate with other departments to resolve claims, quality of care, member or provider issues, and respond professionally to members, providers and regulatory organizations while protecting confidentiality Identify problems or needed changes, recommend resolutions, participate in quality improvement efforts, and provide consistent, accurate documentation Plan, organize and prioritize assignments to comply with performance standards, corporate goals, and established timelines #LI-Remote